Physician and patient perspectives on the treatment of hypercholesterolaemia: a cross-sectional study to identify disconnects.

Abstract

Objectives: Implementation of more stringent LDL-C targets, as recommended by ESC/EAS guidelines, may be influenced by physician understanding of patient preferences. We aimed to understand patient preferences for lipid lowering therapy (LLT) management, perceptions of LLT and unmet needs, alongside physician predictions. We also investigated physician and patient therapy choices in two clinical scenarios.

Methods: 450 physicians (224 primary care and 226 specialists) across Germany, Italy, and the UK were analysed.

Results: Patients reported a high prevalence of unmet needs in relation to support with treatment which was not apparent to physicians. Clinicians underestimated the proportion of patients with doubts about their perceived need for LLT (predicted 40%; actual 64%), treatment concerns (predicted 40%; actual 78.7%), and unmet information needs (32% physician agreement; actual 75%). Despite having negative attitudes to existing treatments, 82% of patients were open to treatment intensification if their LLT was suboptimal (vs. 55% physician agreement). Furthermore, only 16.7% of patients believed repeated prescription changes would lead to non-adherence (vs. 52.4% physician agreement). Presented with case studies, physicians chose progressive LLT more often for the high CV risk case with statin intolerance than for the very high CV risk uncontrolled case (82.7% vs. 61.6%). In both cases, approximately 50% of patients chose progressive LLT.

Conclusion: More comprehensive physician and patient support is needed to optimize LLT treatment. This should address patient and clinician barriers to treatment escalation and facilitate shared decision-making.